description: This extension specifies excluded coverage details within a health insurance product. It outlines services, treatments or conditions not covered.
package_name: ndhm.in
derivation: constraint
name: ClaimExclusion
type: Extension
elements:
  extension:
    short: 'Illustrates a standard or specific exclusion category e.g: pre-existing diseases, specific disease/procedure waiting period.'
    index: 0
    slicing:
      slices:
        category:
          match: {}
          schema:
            short: 'Illustrates a standard or specific exclusion category e.g: pre-existing diseases, specific disease/procedure waiting period.'
            index: 0
            extensions: {}
            elements:
              extension: {index: 1}
              url:
                pattern: {type: uri, value: category}
                type: uri
                index: 2
              value:
                choices: [valueCodeableConcept]
                index: 4
              valueCodeableConcept: {type: CodeableConcept, choiceOf: value, index: 5}
        statement:
          match: {}
          schema:
            short: General statement about the exclusion.
            array: true
            index: 6
            extensions: {}
            elements:
              extension: {index: 7}
              url:
                pattern: {type: uri, value: statement}
                type: uri
                index: 8
              value:
                choices: [valueString]
                index: 10
              valueString: {type: string, choiceOf: value, index: 11}
        item:
          match: {}
          schema:
            short: Outline list of medical illness, associated treatments, as well as other non-medical items that are excluded from the health insurance product. e.g. cataract surgery, skin tumour, baby food etc.
            array: true
            index: 12
            extensions: {}
            elements:
              extension: {index: 13}
              url:
                pattern: {type: uri, value: item}
                type: uri
                index: 14
              value:
                choices: [valueCodeableConcept]
                index: 16
              valueCodeableConcept: {type: CodeableConcept, choiceOf: value, index: 17}
  url:
    pattern: {type: uri, value: 'https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Exclusion'}
    type: uri
    index: 18
  value:
    choices: []
    index: 20
package_version: 6.5.0
extensions:
  category:
    url: null
    short: 'Illustrates a standard or specific exclusion category e.g: pre-existing diseases, specific disease/procedure waiting period.'
    index: 0
    extensions: {}
    elements:
      extension: {index: 1}
      url:
        pattern: {type: uri, value: category}
        type: uri
        index: 2
      value:
        choices: [valueCodeableConcept]
        index: 4
      valueCodeableConcept: {type: CodeableConcept, choiceOf: value, index: 5}
  statement:
    url: null
    short: General statement about the exclusion.
    array: true
    index: 6
    extensions: {}
    elements:
      extension: {index: 7}
      url:
        pattern: {type: uri, value: statement}
        type: uri
        index: 8
      value:
        choices: [valueString]
        index: 10
      valueString: {type: string, choiceOf: value, index: 11}
  item:
    url: null
    short: Outline list of medical illness, associated treatments, as well as other non-medical items that are excluded from the health insurance product. e.g. cataract surgery, skin tumour, baby food etc.
    array: true
    index: 12
    extensions: {}
    elements:
      extension: {index: 13}
      url:
        pattern: {type: uri, value: item}
        type: uri
        index: 14
      value:
        choices: [valueCodeableConcept]
        index: 16
      valueCodeableConcept: {type: CodeableConcept, choiceOf: value, index: 17}
class: extension
kind: complex-type
url: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Exclusion
base: http://hl7.org/fhir/StructureDefinition/Extension
version: 6.5.0